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Aphasia Lecture 4
Neurological-based classifications & behaviors symptoms
64
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Graduate
06/11/2010

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Term
Name the two camps in the history of aphasia
Definition
localizationists, antilocalizationists
Term
localizationists
Definition
Pure localizatoinists believe that every type of linguistic behavior can be localized in a particular part of the brain.
Term
antilocalizationists
Definition
Pure antilocalizationists view the brain as an integrated unit like a hologram and believe that damage to one area of the brain will affect the functioning of the brain as a whole.
Term
Edwin Smith Surgical Papyrus
Definition
(Egyptian) earliest known record of loss of speech recoreded before 3500 BC
Term
Hippocratic Corpus
Definition
(400 BC) Described cases distinguishing aphasia from other speech problems
Term
Franz Josef Gall
Definition
(1758-1828) was the firs man to relate speech to particular area of the brain, the first to clearly identify "gray" (neural functions) & white (conductive) matter. His patient was Rampan who had a posterior left frontal lobe sword wound, right hemiparesis and anomia. Gall died of a stroke in 1828.
Term
Phrenology
Definition
one of Gall's theories that postulated 27 discrete brain centers of behavior based on the outward appearance of the skull. Only two were confirmed: language and word memory.
Term
Bell (1811)
Definition
Differentiated sensory & motor nerves and specified antonomic nervous system.
Term
Bouilaud (1825)
Definition
116/850 patients with frontal lobe lesions had speech defect. Strong supporter of localization.
Term
Flourens (1824)
Definition
Antilocalizationist -- all brain parts had equal potential. if damaged, other areas would take over function.
Term
Paul Broca (1824-1880)
Definition
Professor of surgery & anthropology in Paris, discovered the motor speech area in the 3rd convolution. He first called aphasia "aphemia"
Term
Carl Wernicke (1848-1905)
Definition
German neurophsychiatrist who discovered "sensory aphasia" when he had a patient who had a stroke and was able to speak & hear, but barely understood what was said to him.
Term
Controversy: Anti-localizationists
Definition
Late 1800's & early 1900's - linked the impariment of language to the impairment of underlying intellectual capacity by applying general psychological principles and they formed psychological-based taxonomies explaining aphasia.
Term
Origin of Simplistic concept: expressive vs. receptive
Definition
screened 234 aphasic patients and concluded 3 types of aphasia: predominantly receptive, predominantly expressive, amensic
Term
Geschwind
Definition
discovered 2 types of aphasia: fluent and non-fluent.
Term
fluent aphasia
Definition
>5 words per utterance but without semantic meaning.
Term
non-fluent aphasia
Definition
<5 words per utterance and without syntactic features.
Term
Contemporary viewpoint of aphasia
Definition
Aphasia is both an anatomical (localized) and cognitive neurolinguistic disorder (syntax, semantic, pragmatic)
Term
Primary motor area
Definition
Flaccid paralysis opposite side
Term
Prefrontal area
Definition
Cognitive deficits, distractability, personal/intellectual deterioration
Term
premotor area
Definition
visual motor deficits, initiation of speech & cognition
Term
Inferior frontal gyrus
Definition
Motor speech deficits,less complicated dysarthria to Broca's aphasia
Term
Aprosodia or dysprosodia
Definition
inappropriate emotion & gestures to corresponding language.
Term
Abulia
Definition
Lack of spontaneity; akinetic mutism
Term
Motor impersistence
Definition
unable to maintain motor act-tongue protrusion
Term
confusion
Definition
faulty judgment, memory, lability, disoriented
Term
emotions
Definition
indifferent; unconcerned; apathetic; unmotivated
Term
Right frontal lobe pathology
Definition
Aprosodia or dysprosodia, abulia, motor impersistence, confusion, and emotions
Term
Right temporal lobe pahtology
Definition
Low scores on perceptual & memory tasks; facial agnosia; impaired nonverbal auditory discrimination; tonal memory deficits; anterior tip: behavioral deficits
Term
Right Parietal lobe pathology
Definition
dressing apraxia; somatoagnosia; visual spatial deficits; facial agnosia; spatial dyslexia; spatial dysgraphia; arithmetic difficulties; writing problems; construction aphasia
Term
Occiptial lobe pathology
Definition
visual association areas, unable to recognize objects on the basis of visual information although visual acuity is normal.
Term
Language-based communication disorder
Definition
An impairment of comprehension or production of communication secondary to cognitive, linguistic, and/or pragmatic impairment.
Term
cognitive
Definition
processes by which sensory input is transformed, reduced, elaborated stored, recovered and used.
Term
Linguistic
Definition
Processes of language content, form & use
Term
pragmatic
Definition
rule-based processes for conversing with different partners & contexts & intitiating, maintaining & terminating discourse & conversation
Term
Aphasia is NOT
Definition
generalized intellectual deficit; apraxia of speech; sensory deficit; psychiatric disorder; dysarthria
Term
dysarthria
Definition
motor speech incoordination/weakness disorder
Term
____% right handed are left hemisphere dominant for language
Definition
98
Term
___% of left handers are left hemi dominant, ___ % right dominant and ___% have language competence in both hemispheres.
Definition
60; 30; 10
Term
Hemisphere dominant for preferred hand is usually dominant for _____________
Definition
language
Term
When is brain dominance complete?
Definition
studies of brain damaged children suggest that dominance is not complete before adulthood.
Term
Anatomic model for spoken language (1)
Definition
Auditory patterns with meaning (phonemes) stored in Wernicke's area in the left temporal lobe. Activated when a spoken word is recognized or when an intended word is to be spoken.
Term
Anatomic model for spoken language (2)
Definition
Word to be spoken, its auditory form (phoneme) is sent from Wernicke's area through supplemental motor area, cingulate gyrus & connections via the caudate nucleus to Broca's area then to primary motor cortex (atriculem). Sent via large fiber bundle(arcuate fasciculus)
Term
Anatomic Model for Written language (1)
Definition
Perception of written symbols (visulems) in primary visual cortex & visual association area of occipital lobe. Information sent to angular gyrus in parietal lobe. Symbols associated with acoustic image (phonemes) as meaningful word.
Term
Broca's Aphasia
Definition
Extremely non fluent; halting & labored speech production; misarticulations (paraphasias); agrammatic to very restricted vocabulary availability; grammar structures restricted to overlearned forms; naming difficutlies; auditory comprehension relatively intact, but is affected; reading mild to moderately affected; handwriting usually poor (hemiparalysis); resembles speech output
Term
Anatomical Locus for Broca's aphasia
Definition
3rd inferior frontal convolution; close proximity to motor area of face, hand arm, leg on motor strip.
Term
Phenomenology of Broca's Aphasia
Definition
Linguistic difficulties arise from the inability to plan & execute coordinated sequences of movements necessary for fluent speech; not due to paralysis of speech muscles; structures cannot produce coordinated voluntary speech output without struggle; reflexive, automatic movements are normal.
Term
Global Aphasia
Definition
Extremely non-fluent; severe impairment across all modalities; little to no speech production; severe auditory comprehension deficit; inability to repeat or name; inability to write (severe paralysis); better copying than matching; inability to read; significant oral & limb apraxia & construction apraxia; emotionally labile.
Term
Anatomical Locus of global aphasia
Definition
Very large left frontal lobe lesion; may encompass entire middle cerebral artery coverage area (frontal, parietal, and temporal lobes)
Term
Transcoritcal Motor Aphasia
Definition
Non fluent aphasia; non-fluent verbal output within the context of relatively spared comprehension (Visual & auditory); no conversational speech; spared repetition for words & sentences; Reading ability variable; writing is always impaired.
Term
Transcortical Motor Aphasia Anatomical locus
Definition
An anterior "border zone" lesion -- vascular area where middle cerebral artery and frontal cerebral artery merge. Just anterior or superior to Broca's area and involving some subcortical areas.
Term
Wernicke's aphasia
Definition
fluent aphasia -- significant auditory comprehension deficit (common names of objects; more significant for sentences); word finding severely restricted with speech content empty & with circumlocution. Speech may be rapid & unaware of output errors.
Term
Paraphasia
Definition
Production of unintended word, syllables or phrases.
Term
Literal Paraphasia (phonemic paraphasia)
Definition
Easily articulated individual sounds; syllables in wrong order; word distortion with unintended sounds
Term
verbal paraphasia (semantic paraphasia)
Definition
Unintended word inavertently used in place of another.
Term
Neologisms
Definition
jargon
Term
Wernickes'a Aphasia anatomical locus
Definition
Entire posterior portion of the first temporal gyrus. Lesions spreading more posterior into angular gyrus area may produce severe reading & writing disorders.
Term
Conduction aphasia
Definition
AKA disconnect syndrome -- speech fluent but with significant phonemic paraphasias; tries to correct errors; may resemble stutter-like blocking; relatively preserved auditory comprehension; significant anomia; remarkably preserved auditory comprehension; significant anomia; remarkably poor repetition of words/sentences; reading comprehension relatively well-preserved; oral reading mirrors speech output; writing selectively impaired paralleling speech output.
Term
Conduction aphasia anatomical locus
Definition
A selective white matter lesion of the arcuate fasciculus; lesions more likely in the supramarginal gyrus area.
Term
Transcortical sensory aphasia
Definition
Fluent and paraphasic; significantly impaired auditory comprehension; remarkably well-preserved repetition; aside from excellent repetition, appear very much like Wernicke's aphasics; Paraphasia: semantic word substitutions; severe anomia; reading & writing significatnly impaired.
Term
Transcortical sensory anatomical locus
Definition
Deep lesions in the angular gyrus area and between the posterior end of the Sylvan fissure and the teporo-occipital junction
Term
Anomic Aphasia
Definition
Notable word-finding failure affecting primarily nouns & words of high content values; may attempt vague circumlocution substitutions; speech is fluent-rate, syntactic form, articulation normal
Term
Anomic Aphasia anatomical loci
Definition
Angular gyrus, frontal lobe, inferior temporal gyrus; characteristics my vary with each location.
Term
An SLP's Observation
Definition
Knowing classifications has merit; knowing if patient is Broca's or conduction is of limited value in treatment; SLPs must assess for all features of communication and make decisions for treatment based on clinical observations and not medical diagnoses or classifications.
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